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Fire in the Madhouse

Existentialists challenge you to buck conventional wisdom – I am not sure about, ‘conventional,’ but Tobacco Control certainly bucks wisdom. However, there is an area of existentialism which asserts that one is anything that an individual thinks she/he is. I think that this is the principle that this collection of organisations are following. Take for example…

Nicotine is deadly and very, very bad, unless, it is, ‘my’ nicotine.

Up until very recently, nicotine was thought to be highly addictive, a dangerous poison, and some (still) argue that it is carcinogenic: This, I suppose, is understandable given its close association and cofuscation with tobacco smoking, but, for the most part, it is accepted that nicotine does not cause cancer, is not so highly addictive as once thought, and, as far as the levels contained in e cigarette liquids are concerned, is no more toxic than dishwashing liquid (and that is only the higher concentrations). There are studies which do indicate a theoretical connection between nicotine and cancer, but they are far from conclusive. For those of you who wish to read more about nicotine, smoking and harm click here.

Moving back a couple of years: when e cigarettes started to become popular; when the pharmaceutical giants began to feel threatened; when governments realised the impact these infernal newcomers would have on their revenues, the Tobacco Control machine ground into action. Using the funding from Pharma and governments and using their bought politicians – and bought / deceived doctors and scientists, the nicotine scare was promoted. (For an indication of the power and influence of the pharmaceutical industry within the UK Government see, here,) (For a general outline of the pharmaceutical industry and its methods and influence, see here. [My own blog I am afraid]) Add to this Tobacco Control links to the media and nicotine was further demonised. For example, “Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes,” was the headline in the New York Times of March 23, 2014. The paper intimates that e cigarette liquid spilt onto the skin was life-threatening. Typical of the scare stories and dramatic headlines was, “A New Warning about E-Cigarettes and Heart Attack Risk.” This headline was generated after Chi-Ming Hai of Brown University unveiled his findings at the American Society for Cell Biology’s annual meeting in New Orleans (2013) after publication in the journal, Vascular Pharmacology. Headlines from single studies appear to be replicated on a huge scale, from serious medical publications all the way down the line to the tabloids. The aforementioned study generated, “ It’s Not The Smoke, It’s The Nicotine: E-Cigarettes May Damage Arteries.” And moving into 2014, still the story persists with the headline, “E-Cigarettes: Tobacco-Free, But Your Heart May Still Be at Risk: Electronic devices still carry the dangers of nicotine.” The same study was being presented as evidence: The repetition of headlines all over the world was not slowed by the counter arguments of some of the world’s leading experts on the topic – was not slowed by the irrefutable evidence provided over many years of snus use in Sweden, but I am afraid that the facts do not seem to matter when weighed against the power of the media and the ability of industrial giants to fund both the ‘research’ and then the subsequent, massive media campaigns. Carl V Phillips sums things up very succinctly, here.

But the debate over the issue of potential risk by nicotine is secondary: the objective here is to demonstrate the hypocrisy ingrained in the pharmaceutical industries’ campaign against e cigarettes, via, of course, Tobacco Control.

Who or what is Tobacco Control?

Following on from the work of Richard Doll who publicised the causal link between smoking and lung cancer in 1952, there were moves to curtail smoking but this was not wholly satisfactory. This was followed by the creation of the World Health Organization Framework Convention on Tobacco Control or FCTC for short. This is a treaty where nations have signed up to follow certain protocols. For an overview, click here. The FCTC control and encourage most of the myriad of research, educational, publicity, medical and governmental activities to do with the ‘intended demise’ of tobacco products. This, in short, means that any organisation whose stated aims are ‘seeing an end to the use of tobacco products,’ particularly if they are influenced and / or funded by government, or, are influenced and/ or are funded by organisations who are influenced and / or funded by government. Complicated, is it not? But it means that just about any organisation that stands in opposition to tobacco use is part of Tobacco Control. But where does this leave the pharmaceutical industry? Never forget the pharmaceutical Industry: never leave them out of the equation.

National governments provide funding, but there is a great deal more… in fact, so complex it cannot be addressed by me effectively, however, if you wish to examine the money trail, click here. Enough said that the pharmaceutical industry pumps billions upon billions into Tobacco Control. In fact, I would go as far as to say that Tobacco Control groups ARE the pharmaceutical companies: Well, maybe not, but pharma certainly appears to be the puppet master. But here is the odd one – the tobacco companies also support Tobacco Control. Here. And, back to the pharmaceutical industry, they support cigarette smoking – that’s right…. Pfizer had the following to say about its relationship with Heartland, “Our company and its stakeholders derive significant benefits from our involvement with these organizations, which help advance our business objectives related to healthcare policy.”You can read about heartland’s stance on smoking here. It is a right old mess, but I will leave you to work out for yourself why pharmaceutical companies support both anti-smoking and pro-smoking organisations. Now back to nicotine.

The American cancer Society had this to say about nicotine in e cigarettes, “We do know that electronic cigarettes are designed to deliver nicotine, and nicotine is addictive. This strongly suggests that e-cigarette use will lead to dependence, unless the user weans him or herself from them. Fair enough comment, I suppose, if, nicotine is ‘highly addictive.’ But look at what the same article goes on to say, “There are proven methods available to help people quit, including pure forms of inhalable nicotine as well as nasal sprays, gums, and patches.” So, it would seem that e cigarette nicotine is addictive, BUT NRT nicotine is not. Warning! The article also contains the usual rubbish, i.e. Anti-freeze found in e cigarette: It quotes the CDC study on youth usage – That is the one where the headline was a huge increase of young people using e cigarettes but forgot to mention a huge corresponding decrease in cigarette smoking. Well, they did mention it – a year after the headlines. Similarly we read about youth e cig usage in 2014, here. The CDC press release can be found, here. I have added this to demonstrate how unreliable much of the criticisms about e cigarettes are. The same applies to warnings about nicotine’s effect on the lungs and the heart. How is it possible for warnings to be issued about nicotine in e cigarettes on one hand, and claims of safety on the other when applied to their own products? According to the opponents of e cigarettes – sorry – the pharmaceutical industry via the opponents of e cigarettes, nicotine is very, very bad, unless it is their nicotine.

This substance is used in many products and is generally considered to be safe. However regular inhalation via e cigarettes is a new phenomenon and opponents of e cigarettes, Tobacco control – sorry – the pharmaceutical industry via Tobacco Control have made it sound absolutely terrifying. Right from the beginning the organisations and groups under the Tobacco Control umbrella have screamed (and yes, ‘screamed,’ is the operative term) that e cigarette liquid contains anti-freeze. Here they are talking about propylene glycol. On the 22nd July, 2009 the FDA issued a warning that e cigarettes contained antifreeze. From that point, to this day, approximately six years later, the story persists. This is despite the truth of the matter having been revealed.

Now, I am not a scientist or doctor, in fact I have only a modest education, yet, if you look closely at the Chest report you will see that the doctors make the ‘schoolboy’ error of thinking glycerol is a lipid (and I would not have known that) but, they fail to find the real cause of the illness. Now (again) I think I can – I am not saying this because I wish to boast, though I am feeling rather smug. I am using it to point out that the doctors did not just make one glaring mistake, they made two. I am using it to demonstrate how prejudice can blind, even an expert mind, where something can be so very obvious, but is missed. The Chest article states, right at the beginning….

Any scientists and doctors reading this will see in an instant the potential cause for the woman’s condition – I had to work my way through them. I wish they had put, ‘albuterol metered dose inhaler,’ at the beginning of the list. Here, on investigation I came across one of the ingredients… oleic acid… a lipid. So how did these doctors make a silly mistake in classifying glycerol as a lipid and on top of that, fail to see the real cause (if it was such)?

It happened because they were so blinded by their prejudice they failed to see what even a rank novice, worse, someone with no scientific training whatsoever could see. The article ends with the comment that the woman’s condition cleared after withdrawal from e cigarettes, but, would her inhaler not have been withdrawn as well? It appears to me that the woman’s recovery was down more to good luck than anything else.

Nonetheless, the story hit the headlines

It would therefore seem that medically approved devices with propylene glycol can result in lipoid pneumonia but they are ok,however, e cigarettes which contain propylene glycol are not… unless… they are medically approved e cigarettes or similar. For example, the new Voke produced by a tobacco company and making its way, so far with success, through the MHRA maze of regulation, and, the existing NRT spray.

Using devices where one looks like smoking is setting a bad example and very, very bad unless it is, ‘my’ device one is using.

I am tempted just to write, ‘ha-ha, ha-ha, ha…,’ here but I will go one better. It would appear that Tobacco Control, sorry, the pharmaceutical industry through Tobacco Control, have not got the intuition / common sense of primary school children. A recent, albeit, small study was conducted in New Zealand where young children were asked what they thought when they were shown e cigarettes being used. At first they confused the devices with smoking, but many did note differences such as the fact that they were not being lit up before use and that they were being placed in the users pockets in between puffs. The net result of the study was that when the youngsters understood what the devices were and why they were being used, they thought that e cigarettes were a good thing: “they should normalise quitting behaviour.”

I have mentioned the Voke which is soon to be presented as a medical device and, in all honesty it cannot be mistaken for a tobacco cigarette. This is the Voke

As you can see, it is nothing like a real cigarette.Here, on the other hand, is an e cigarette of the kind the regulators and Tobacco Control, sorry, the pharmaceutical industry through Tobacco Control, will see an end to. You will note the similarities of the device and a tobacco cigarette.

“Looks like smoking” – are they nuts?

Toasters are very, very bad and must be banned unless the toast is produced without first heating the bread.

One of the main selling points of the Voke is that it operates without heating. In the advertising blurb this is emphasised. It is no coincidence that some (very bad) studies and articles have been appearing lately arguing that formaldehyde and metals have been found in e cigarette vapour.

A report was published in the New England Journal of Medicine claiming that, at high temperatures, more formaldehyde was produced by e cigarettes that from conventional tobacco cigarettes. And, once again the media latched on and the news was spread around the globe. There were, however, a number of weaknesses and these were highlighted by Dr. Konstantinos Farsalinos. Here. Without going into the detail (the link is there for you) no one in their right mind would use an e cigarette at the temperatures suggested in the original study.

This is the equivalent of what the researchers produced and vapers would no more use e cigarettes at the temperatures needed to produce the toxins discovered any more than you would eat burnt bread like this. But the results of studies like this, and I include inaccurate conclusions and fear inducing tabloid style headlines as, ‘results,’ are part of the case being made against e cigarettes and vaping.

Products of an established level of safety are not safe and very, very bad because they are not proven to be such: The medical product is of a proven level of safety, because we say so.

Medicalised devices are approved in the UK by the MHRA. Many countries have similar organisations to control medical products. The claim is that licencing by the MHRA ensures safety – does it really. On the other hand e cigarettes have been adequately demonstrated to be 95% – 99% safer than conventional cigarettes. They are nearly always used by cigarette smokers looking for a safer alternative.

Virtually every single study conducted by world experts either establishes a relative level of safety or fails to establish any real danger. I have not come across anything which would prevent me from vaping and I have read a great deal over the last two or three years.

I would go as far as to say that the MHRA cannot be trusted any further than the FDA and CDC in the US on their commentary about e cigarettes. The pharmaceutical industries’ hold on government is just too great: their pockets are just too deep; history demonstrates a catalogue of errors and sometimes even deliberate deception by pharma in order to sidestep the regulation supposedly supervised by regulatory bodies – indeed these organisations designed to protect us have been subjected to so much ‘creep,’ I do not consider them to be anything more than extensions of the pharmaceutical industry itself.

A 1914 UK Government Select Committee had this to say,

“After careful consideration of the evidence laid before them your Committee find: That there is a large and increasing sale in this country of patent and proprietary remedies and appliances and of medicated wines. That these remedies are of a widely differing characters, comprising genuine scientific preparations; unobjectionable remedies for simple ailments; and many secret remedies making grossly exaggerated claims of efficacy… That this last-mentioned class of remedies contains none which spring from therapeutical or medical knowledge, but that they are put upon the market by ignorant persons, and in many cases by cunning swindlers who exploit for their own profit the apparently invincible credulity of the public. That this constitutes a grave and widespread public evil…”

“These problems … reflect its (Pharma’s) influence. People have been taking ineffective and harmful medicines for centuries. However, there is reason to fear that the industry has positively nurtured anxieties about ill-health. The fundamental problem, it is alleged, is that the industry is increasingly dominated by pressure from its investors and the influence of its marketing force and advertising agencies rather than its scientists. The industry is hugely influential, affecting every aspect of the medical world, including prescribers, patients, academics, the media, and even the institutions designed to regulate it. Its influence in Parliament is extensive.”

And when a regulatory organisation claims ‘safety,’ is it really: This from the US. “The FDA buries evidence of fraud in medical trials.” Here

Or how about, “The extent of industry influence over drug regulation, at the expense of other interested parties suggests that the current system could be more robust.” ‘Suggests … could be?’ Well, it is The Lancet after all. Here

Then we have, “Institutional Corruption and the Pharmaceutical Policy.” This from Marc A. Rodwin Professor of Law, Suffolk University Law School: Here.

There is so much more but I think the above is enough to establish that, ‘safe,’ from the MHRA or other regulatory organisations does not actually mean, ‘safe.’

A tobacco product is a medical product when something which is not a medical product has to be considered a tobacco product, (Not too sure which one, or both, or none, is very, very bad, but, in the spirit of the madhouse, who cares!) but if the product is not a medical product, OR, a tobacco product it must be very, very bad, because it is neither, OR, it is very, very good. (For much the same reason)

I am still trying to work out what I mean by this. It has to do with early attempts to maintain that e cigarettes were medical products with the subsequent legal challenges and the realisation that they could not be classified thus, then the claim that they are tobacco products which they are patently not, and now the production of a tobacco product, which it is patently not, where the MHRA are classifying it as a medical product – see what I mean?

Anyway, it is a consumer product. Simple really!

A pharmaceutical company is still a pharmaceutical company even when it is a tobacco company, or is it the other way round?

A little dig at pharmaceutical companies which have interests in tobacco companies and vice versa.

ANYWAY

Would someone call the emergency services, there is a fire in the madhouse.

A recent study, entitled, Effects of in-vivo and advert observation of e cigarette vaping and smoking desire and urge in young adult smokers. purports to support the view that watching someone smoking or vaping increases their desire to do the same, whereas, seeing someone drink a glass of water, does not have the same effect. http://www.srnt.org/SRNT_2015_Abstracts_WEB.pdf

Well I never!

The researchers claim that they directly tested the impact of observing e-cigarette use by in-vivo and advert exposure in young adult smokers.

They did nothing of the kind!

They then build on the above mistake (fabrication) to reach the following conclusion… “Results from Study 1 showed that observing water drinking did not affect participants’ smoking desire or urge ratings. However, observing both e-cigarette vaping and regular cigarette smoking significantly increased combustible smoking desire and urge (ps<0.05) with observation of e-cigarette vaping also increasing e-cigarette desire (p<.01). In Study 2, viewing the e-cigarette advert increased ratings of desire and urge to use a combustible cigarette and an e-cigarette (ps<0.05) but this was not the case for the water advert. Further, these increases in smoking urge were significant for both positive and negative reinforcement effects. In sum, this research is the first to our knowledge to examine direct observer effects of e-cigarette use which may act as a cue to increase desire for both combustible and e-cigarettes. The results may have implications for product regulation and marketing. Results expand the debate about e-cigarettes to include effects on persons exposed either in person or by advertisement to product use.”

So did the researchers directly test the impact of observing e-cigarette use by in-vivo and advert exposure in young adult smokers? I am very much afraid that they did not.

Let me digress slightly: I am not a scientist, doctor, advocate, or anything like it. Indeed I have only a modest education by comparison to the PhD’s who litter (pun intended) the document where I found the above. So how is it that a few minutes thought reveals to me a glaring weakness in the study which has supposedly gone unnoticed by the ‘experts?’ It, I think, has not, and if it has not, the research here is a downright lie.

First of all the researchers were: Andrea King, Lia Smith, Daniel Fridberg, Dingcai Cao, Patrick McNamara, Hannah Resnick, Norvel Brown, belonging to one of the following: University of Chicago, Department of Psychiatry & Behavioral Neuroscience; University of Chicago; Department of Psychiatry & Behavioral Neuroscience and / or University of Illinois at Chicago, Department of Health Systems Science – Wow! Impressive!

The reason for my admission that I am not a scientist is so that I can get away with what follows, or, if you can cheat to get the results you want, so can I. Except for the fact that I admit to cheating and explain in detail what the cheat is.

The cheat is that I will base everything on an assumption, but that assumption gives the lie to the idea that this research directly tested the impact of observing e-cigarette use. As pointed out, all of the researchers belong under the same umbrella organisations, the Universities of Chicago & Illinois and my assumption is that the research took place within the premises of these esteemed seats of learning. If I am correct, everything they claim goes absolutely pear-shaped as a result. How can that be?

It is very, very, very simple.

Take a look at this UIC page , http://www.uic.edu/uic/about/tobacco-free/index.shtml and this one https://humanresources.uchicago.edu/fpg/policies/600/p603.shtml (Note the last paragraph about the hospitals’ policy.) So the poor smokers participating in the research were not allowed to smoke or vape prior to the experiment – how long I wonder? They finally are admitted to the building and are already thinking about their next smoke / vape. The big moment arrives and they are seated, and next to them are two glasses of water. The researcher drinks from his/her glass, ‘so what! The subject wants a vape / smoke not a drink of water. You see, the desire has already been created – even before setting foot in the room. What happens with the cigarettes and the e cigarettes is a complete irrelevance. Given the opportunity to have a cigarette or vape will be pounced upon by the poor deprived subject whether he / she observe someone else doing it or not – the whole experiment is a complete and utter farce. Equally, when shown images of someone doing something which you already desperately want will obviously demonstrate some reaction, and the same would happen with water if you were thirsty enough.

A smoker or vaper’s desires are not dictated by the actions of others or by what he / she sees going on around them. Being deprived of something though does increase desire, and being reminded of it simply brings to the surface feeling which have been repressed.

The one and only thing this research establishes is that smoking and vaping bans increase the desire to indulge in the activity which then shows in the subject’s response.

And psychologists, you know, the ones with the qualifications, failed to realise this? No chance!

A little prose/poetry story dedicated to the World Health Organisation

A quiet moment and he drummed his fingers on his desk. Another year had turned: Another year of the pain he had shared so willingly – shared so secretly. Another year had turned, and still the snake on the staff stayed his hand. The doctor failed to understand the snake’s demand, to cure the sick, to do no harm, but also keep silence: To give advice when he, the doctor, knew it wrong to hand out lies, prescribing only second best. Gums and patches, and the rest – all failed. He drummed and drummed his fingers on the desk

A year had passed since that evening when that crowd had gathered on the excited street below, and, looking down, he remembered how the jostling and the clamour grew. ‘We have something new.’ They cried. ‘Look Doctor, we have something new.’ And each and every one held up a light. ‘We no longer have to fight.’ They cried. ‘Look! We no longer have to fight.’

The snake had also heard and had slithered down from off its stick. And shocked, the doctor saw the venom drip from hidden fangs, and from the window backed away. ‘Cure the sick and do no harm,’ the creature hissed. ‘Those outside, they won’t be missed. Give out only lies and second best, and if that fails, well, prescribe some rest. But be warned, dear doctor; say nothing of what you saw tonight. Say nothing of that awful blinding light that burns me to my very soul. Say nothing.

And thus the doctor, on the snakes command, stayed silent and said nothing of what he’d seen. Yet, in bed at night, he’d dream that in his hand there was a light which cured the sick, but on awakening all he had was a snake curled round a wooden stick.

“I am concerned that e cigarettes will act as a gateway into smoking.” This is a lie, but how to prove it? Actually it is very easy. You see there is now such an abundance of evidence that this is not happening that, any ‘expert’ must be aware that there is no gateway effect. Add to this the twisting of statistics and other shoddy and desperate tactics, and it is easy to see that the advocates of this concern must be the ones most aware that they have no need to be concerned in the first instance.

Look at the statement, “I am concerned that…” This is often read to mean that there is some danger that ‘it’ might be happening, or might happen sometime in the future – but the evidence says otherwise.

I could claim to be concerned that the moon might fall out of the sky, but my experience says otherwise, and no one would believe that this was a genuine concern. I could express concern that the next car heading towards me will suffer catastrophic brake failure and run me down, but my experience says otherwise, and I would be mad to live my life thinking about this kind of possibility.

I could parade in the shopping centre with a placard saying, “The end of the world is nigh.” Let me rephrase that, “I am concerned that the end of the world is nigh.” And people would walk past and when past, smile a little. So when professors of Public Health state that they are, “concerned those e cigarettes might lead to cigarette smoking,” why does no one walk past smiling?

“Regular use of electronic cigarettes amongst children and young people is rare and is confined almost entirely to those who currently or have previously smoked.”

So despite the evidence, despite the fact that it is not happening Public Health officials repeat the dire warning and express their concern. Concern! Concerned about something that is not happening, has never happened and is not likely to happen – what next? The end of the world perhaps?

Or, when used by health advocates against the use of e cigarettes, the twisted nature of the cry, “Think about the children.”

In 1996 Helen Lovejoy, a character in the TV programme, ‘The Simpsons,’ pleaded, “Won’t someone please think of the children!” This has become known as Lovejoy’s Law. This is a plea which has been made repeatedly, not just in the TV programme, but by individuals and organisations opposed to the development and public use of e cigarettes.

There are two purposes for the use of the plea, ‘think about, or, what about the children.’ One is legitimate for use in reasoned debate – the other is not. It is legitimate to use the question to draw attention to the plight of children: It is not legitimate to use it to detract from logical argument and where it becomes an appeal to emotion. So when Anti-Smoking organisations and health bodies take up the cry, “Think about the children.” How exactly is it being used? Is it part of a reasoned debate on the topic of e cigarettes, or is it an appeal to emotion – a logical fallacy?

The history of the appeal goes back, back before the popularity of e cigarettes had been established, in fact, before the opponents of e cigarettes had even heard of them, and, ironically, to a time where they were wishing that they did exist. That is correct: The very same people who object to vaporisers now, when they were dreaming as if they were something out of science fiction, had once placed them at the top of their wish lists.[i]

In October 2008, Action on Smoking and Health, produced a document called, “BEYOND Smoking Kills.” It was funded by The British Heart Foundation and Cancer Research UK. It was endorsed by a mass of health organisations and charities, and by many local authorities. It is, however, the sub-title I find interesting: “PROTECTING CHILDREN, REDUCING INEQUALITIES.”

This is where they, and we, I am afraid, get into a bit of a muddle. You see, based on conventional wisdom – based on what was truly believed to be the dangers of smoking cigarettes (and second hand smoke)[ii] by ‘those in the know,’ to demand that we, ‘think about the children,’ was legitimate, rational and logical. However the same document advocates… as a future means to protect the children… the e cigarette… but not in so many words. So, if, now, the e cigarette is a threat and we must, ‘think about the children’ in the face of this threat, how can it be that the people advocating this were, at that time, praying for the very thing that has been developed to fit their criteria[iii],… the e cigarette… as a means of protecting the children?[iv]

So the e cigarette was a means of protecting children then, and is a threat to them now? Hardly!

In fact, what we have is the same argument being presented in favour of two very different scenarios. The problem is that it just does not seem like two different scenarios.

And this is the crux of the matter. This is why I have presented to you what is contained in the document, “Beyond Smoking Kills.” The appeal, “think of the children,” was based on a genuine desire to save countless lives where young people were being attracted to a deadly habit. However, when applied to e cigarettes the same does not hold true.

Children are not being ‘attracted’ and the activity is not ‘deadly.’ There is no evidence to suggest that children, who are never-users of cigarettes, are taking up and using e cigarettes. We have to be careful with statements like this, for two reasons. There is an important difference between the terms, ‘using,’ and, ‘trying,’ and that never-users of tobacco cigarettes, may, in the future, begin to use e cigarettes. I wish to deal with these separately.

That there is a difference between, ‘using,’ and ‘trying:’ to see the importance of making a definition between the two words, look at an early CDC report which confused the two. On the 5th of September 2013, the Centres for Disease Control & Prevention (CDC) issued a press release. The headline and sub-heading screamed, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012. More than 75 percent of youth users smoke conventional cigarettes too.”[v] (You will note that I used the word, ‘screamed’ here. It is an emotive term, and, as previously stated, emotion is a powerful tool when trying to convince someone about something – the question you have to ask is, ‘is the use of the device justified?)

Well, in the case of this headline, I think I can justify the use of the word, ‘screamed.’ The first reason is that this press release was taken up world-wide by the press. The story was a dominant one. Newspapers, television and radio all over the world featured it. But it was the emotion which carried the story, not the substance. The report itself did nothing to support the headline. As Carl V. Phillips stated, “The biggest lie is that they report nothing about use.[vi] All the reported statistics are about trying the products.” There is a great deal more wrong with the headline but the confusion between, ‘using,’ and, ‘trying,’ is my main concern here. Enough to say that e cigarette use had not doubled as the headlines claimed, but the news was out, and it was believed. The emotive message had carried the day.

That young people who have never smoked but who might, in the future, take up e cigarette use is not really a concern either. I would argue that it is to be expected. It is just common sense. It is common sense to expect that among the young people who might be attracted to smoking cigarettes, some will prefer the safer option – but this does not mean that they will go on to smoke tobacco. In fact, why would they? If they enjoy the experience of using e cigarettes, why move over to something which is less enjoyable, and a damn sight more dangerous, and, if they do not enjoy the experience, why try something worse? But the public, generally speaking, cannot see this – they are blinded by emotion: the e cigarette in many minds IS smoking; IS evil; IS dangerous. That e cigarettes might be replacing tobacco smoking actually does seem to be the present trend, though be careful, just because one set of figures is rising does not necessarily mean that this is the reason for the fall in the other – but it looks that way.

I think that one of the better arguments that I have come across is contained in Kristin Knoll-Marsh’s blog which compares the emotion surrounding young peoples’ use of e cigarettes to the furores over sex education and use of condoms. As she states, “They also wring their hands over youth use, worrying loudly that kids will try e-cigarettes and then move on to the more risky behaviour of smoking. (Like anti-safe sex folks argued kids learning about safe sex would lead to more un-safe sex, leaving many people scratching their heads with that logic.) However, after 10 years on the market and increased use by (mostly smoking) youth being widely reported, CDC statistics show that youth smoking continues to decline significantly: Worrying over increased youth use of e-cigarettes while smoking rates are declining is akin to worrying about more teens having sex using condoms while STD and unwanted pregnancy rates are declining.”[vii] (Highlight mine)

But, as it used to be the case with the issues surrounding young people with regard to sex, so it is the case now with the young and e cigarette use.

The users of the phrase, ‘think about the children,’ when applied to smoking, and then to vaping, have found themselves lost in an ethical maze. Happily some are beginning to find their way out. Some of the major anti-smoking organisations and charities are now speaking out against the imposition of banning use in public places[viii]

But we must, ‘think about the children.’ Well, when thinking about children, is it not an idea to see what they think, or do you see them as mindless, naïve and in need of guidance for every step they take? This image of children certainly does not show in a recent New Zealand study which looked at the perceptions of Maori junior school pupils with regard to e cigarettes.[ix] The result of this small but very important study, demonstrates that far from seeing e cigarettes as something that could act as a gateway to smoking, they were seen as the opposite. It was recognised by the little ones (and they were little and not older children)that e cigarettes were being used as an escape from smoking – where does this leave the argument that e cigarette users should be hidden from sight to protect the children?

It is always a temptation in the face of the, ‘think about the children,’ demand to respond by arguing that e cigarettes do not present the children with any threat, however, there is actually no need to do this. As stated at the beginning, there are only two reasons for using the phrase; one is a genuine desire to protect the children from a threat, and the other is to cover up the fact that a threat does not exist. I hope you can see the problem here – if a threat does not exist, how you establish something which is not there? This being the case, one is forced to discuss the alleged danger. All the opponents of e cigarettes have to do is exactly what we have witnessed them doing right from the start, produce a string of unfounded claims, irrespective of the fact that they are not evidenced and use the media to publicise it. A newspaper does not need evidence, just someone to say something… but the damage is done.

The tiny apology, months after the initial publication of the story, does not undo the damage. Here, the readers of the original article have not seen the apology and are convinced that e cigarettes do harm, and added to this they feel the heavy weight of responsibility to protect the vulnerable little ones in our society from this danger. There is no debate now. Any argument to say that e cigarettes do not present danger must not be tolerated, and the ‘evil’ advocates for e cigarette use must be silenced. We must, ‘think about the children.’

Whenever you hear or read, we must, ‘think about the children,’ ask yourself, why this demand is being made. Is it genuine, or is it an attempt to cover the fact that no real danger or threat exists and that the ‘children’ argument is being used as an emotive red herring?

[i] The harm of tobacco can be reduced by helping smokers to quit, reducing exposure to secondhand smoke

and preventing people from starting smoking in the first place. For heavily addicted smokers who are

currently unable or unwilling to quit, there is also the possibility of switching to pure nicotine products (which,

like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives).As smoking is responsible for half the difference in deaths across socio-economic groups, tobacco control also has a major role to play in reducing health and social inequalities. These aims are profoundly inter-linked. Children who live with parents who smoke will breathe cleaner air, and be less likely to become smokers themselves, if their parents quit or switch to pure nicotine products. Poor families will also benefit from the financial savings of quitting.

[ii] For those who do not agree with the argument that second hand smoke presents a danger, do you see how powerful the emotive argument becomes? The same will hold true for those who do believe in the danger from second hand smoke. My wording casts doubt on this and I would ask you to think about your response when you read it.

[iv] Smoking prevalence is declining but not fast enough. Too few people successfully quit every year and too many people start smoking. New ways of driving down smoking prevalence are needed. Smokers are addicted to nicotine but are harmed by the tar and toxins in tobacco smoke. It is therefore possible for smokers who are currently unable or unwilling to quit to satisfy their nicotine craving at much lower risk by switching to pure nicotine products (which, like the current medicinal products on the market, contain only nicotine and not other tobacco derivatives). Although these products are not 100% safe, they are many orders of magnitude safer than smoking. Given the higher levels of addiction among the most disadvantaged smokers, the promotion of wider access to pure nicotine products as an alternative to smoking is an important means of tackling health inequalities.

Currently pure nicotine products are not attractive to smokers as direct replacements for cigarettes as they do not mimic the speed and intensity of nicotine intake that a cigarette provides. Regulation difficulties inhibit the development of more efficient and effective pure nicotine products. As a result, the most toxic nicotine products – cigarettes – are barely regulated while the safest products – medicinal nicotine – are highly regulated.

If they are to compete with tobacco products, pure nicotine products must be sold on equal terms or better: pricing should favour pure nicotine products over tobacco. Public education is also needed as many smokers (and health professionals) have a poor understanding of the relative safety of pure nicotine products including nicotine replacement therapy.

Recommendations

➣ Develop a strategy and an appropriate regulatory structure to improve the acceptability, attractiveness and accessibility of pure nicotine products for use as an alternative to smoking for those who are currently unable or unwilling to quit.

➣ Encourage commercial development of pure nicotine products designed for long-term use as a replacement for smoking.

➣ Develop a communications strategy to counter public misunderstanding of the health impacts of nicotine. This should promote nicotine replacement therapy for quitting and encourage the longer-term use of pure nicotine products as alternatives to tobacco.

➣ Tax pure nicotine products at the lowest rate of VAT.

➣ Evaluate the cost-effectiveness of providing pure nicotine products free on prescription to smokers for as long as they are unable or unwilling to quit.

➣ Increase investment in research into the long-term impacts of nicotine.

[vi]The headline of the press release manages to fit in one lie and two misleading claims, “E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012″. The biggest lie is that they report nothing about use. All the reported statistics are about trying the products, perhaps only once, which is obviously not the same thing (and CDC knows this). Some statistics reported are for “ever having tried” and the others are “tried at least once in the last 30 days”. They misidentify anyone who has tried in the last month as a current user, which is a rather blatant lie. (Of course, some of those who tried recently may well actually be users, but there is nothing in the report that lets us conclude that even one single student is actually an e-cigarette user.)

[viii] ASH recognises that whilst efforts to help people stop smoking should remain a priority, many smokers either do not wish to stop quit or find it very hard to do so because of their addiction to nicotine. For this group, nicotine containing products which have been properly regulated to ensure product safety, quality and efficacy should be available as an alternative to tobacco.

Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe. Electronic cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are a safer alternative to smoking.

In addition, electronic cigarettes reduce secondhand smoke exposure in places where smoking is allowed since they do not produce smoke. Nonetheless, nicotine is an addictive substance, electronic cigarettes currently available are highly variable in terms of delivery of nicotine and product quality, and smokers are uncertain about the effectiveness of the product. There are concerns, as yet unsupported by evidence, that these products may provide a gateway into smoking for children and young people. The regulation of these products, in particular with respect to their advertising, promotion and sponsorship needs to be undertaken with these factors in mind.

In the UK smokefree legislation exists to protect the public from the demonstrable harms of secondhand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation, but that it should be for organisations to determine on a voluntary basis how these products should be used on their premises

Two structured focus groups and twelve individual interviews were conducted with twenty Māori and Pacific children (6–10 years old) in low socioeconomic areas in Auckland, New Zealand. Children viewed short video clips on an iPad that demonstrated an actor smoking a tobacco cigarette, sucking a lollipop or using an electronic cigarette or a nicotine inhaler.

Results

Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the ‘smoking’ behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker’s inability to quit.

Conclusions

In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.

On February 12, 2014, in my blog, An Outlandish Thought[1], I put forward the view that Tobacco Control were trying not to stop, but to encourage people to take up smoking – it would seem that the idea was not as ‘outlandish’ as I first surmised.

It would seem that there is a large body of academic thought which supports the view that horrific images might actually encourage some smokers to keep smoking, and, some non-smokers to take up the habit, and failing that, the images might be ignored altogether.

As far back as 1953, psychologists were looking at the effect of fear in advertising[2]. The results of their investigations were not as you or I would expect. The model which was being presented at that time is known as “The Drive Model.” Part of this model argues that,”… when individuals are presented with threatening information they will be motivated to search for responses that reduce the threat. When a response reduces fear, it is reinforced and becomes part of one’s permanent response repertory. The drive model therefore suggests that higher fear should result in more persuasion, but only if the recommended action is perceived as effective in averting danger.” (Janis, I. L., & Feshbach, S)

Take a close look at the end of the quote, “…but only if the recommended action is perceived as averting danger.” This is a theme which has been continued as the decades roll by. Following the Drive Model was the Parallel Response model (1970) which suggests that fear appeals produce two separate and potentially interdependent processes: danger control processes (efforts to control the threat/danger) and fear control processes (efforts to control one’s fear about the threat/danger)[3] And once again we find that with the horrific message, the way which one turns is decided by the efficiency of the recommendations for avoiding the danger.

As the years passed, the idea was further and further refined; the SEU models, including, Rogers’s Protection Motivation Theory (PMT)[4]. This attempted to explain the effect of fear and when it works, however the PMT model fails to explain why it does not work. PMT and SEU[5] models deal, in the main, with high threat coupled to high efficacy of the recommendations to avert the danger – but what happens if the perceived threat is low? What happens if the perceived efficiency of suggested measures to avoid the threat is low?

But first, a word about the difference between threat and fear, it is assumed that when faced with a threat, fear will follow. This, it is assumed, will result in an action to avoid the threat. And this is the logic SEEMINGLY being followed by advocates of warnings and graphic images on cigarette packs. They say that the fear induced by the images and warnings will encourage people to stop or never start smoking. However, this is not the way it works. It is true that action will follow on from a threat which induces fear, but what will be the nature of the action?

Take the graphic warnings being issued on cigarette packs. In this instance there are two distinct groups who react to these images and warnings. Young people, both smokers and never-smokers and, older established smokers.

What happens when a young smoker, or would be smoker, sees a horrific image on a cigarette pack? The answer, as far as avoiding cigarettes, is nothing very much at all. Why? The image does not induce fear. Why? The threat event is too far away. It is, to the mind of a young person, very remote – it can be ignored. Perhaps this explains why horrific images are being found to be so ineffective. Perhaps this is why the uptake of cigarette smoking among the young remains so high. A month is a lifetime to many youngsters, so how long is ten or twenty, how long is thirty or forty years away? How far away is, ‘if at all?’

And with established smokers the effect is different but with a similar result Take note that “…the more one is defensively resisting a recommendation the less one is making appropriate changes in line with the message’s recommendations[6].” And, “…that messages that fail to make people believe the recommended response is effective and/or that they are able to perform the recommended response produce stronger fear control/defensive response[7].” I hear an echo reaching me from 1953… listen carefully, does it say, wait for it “…but only if the recommended action is perceived as effective in averting danger.”

The Meta analysis of Fear Appeals: Implications for Effective Public Health Campaigns, (Kim Witte, PhD Mike Allen, PhD) sums things up rather nicely:” In sum, fear appeals appear to be effective when they depict a significant and relevant threat and when they outline effective responses that appear easy to accomplish. Low threat appeals appear to produce very little, if any, persuasive effects. Thus, regardless of which theoretical model is advocated, the advice to message designers is the same: a persuader should promote high levels of threat and a high level of efficacy to promote attitude, intention and behaviour changes.”

So look at the gruesome image on the packet. Read the warning, “Smoking Kills.” And now look at the recommended action… Sorry, I will reword that statement, look FOR the recommended action – No, I do not see one. Ok, so it is implied, ‘stop smoking.’ Will that be perceived as ‘effective’ advice? Well, maybe effective if it was within some range of possibility, but is it? Even the best reported results for quit attempts is hardly 10% – so the messages (implied) recommended action, in practical terms is, 90% fail. Not good. Not effective, so other defence mechanisms kick in.

What are they?

They might, scrutinize the message to find ways to criticize and downplay the information in order to reduce the threat. They might, engage in a biased search for inconsistencies, and evaluate the evidence with a bias in the direction of their preferred conclusion. And always, the spectre of another failed attempt to follow the recommended action: ‘stop smoking.’

So the young see the threat as being something in the distance, something that can be dealt with later – the threat level is low. Adult smokers despair at the recommended action, and although the messages and images may create fear, the recommendations are not realistic, the efficacy is low, and so denial takes place.

Messages and images have only a very limited impact in smoking cessation.

The same holds true for plain packaging and for hiding cigarette products out of sight. In fact, these actions can be seen to be an attraction for young people – a reason to start smoking, not resist.

There is a mass of information on the psychology of the attraction of the unknown. Couple this phenomenon to the advertised (low) threat value of cigarette smoking to locking cigarettes out of sight, and a large percentage of young people will find the allure that has been created, irresistible.

But what is worse – I believe that Tobacco Control is aware of all of the above.

How would they know?

The answer is a very simple one. A very large proportion of the psychology of fear appeals, and communications, and attitude change are written for the advertising industry. This includes the health advocates who use this particular advertising to create the effect they desire. Now, we encounter a slight problem. What exactly is the effect they desire? If they are not aware of the effects of presenting warnings without effective avoidance strategies, they are negligent. If they are aware that warnings and gruesome images, that hiding cigarettes out of sight will have no effect, and indeed be an attraction – they are culpable.

I choose to think it is deliberate. Tobacco Control is expert at marketing. It, I believe, knows the psychology involved inside and out. Whole university departments give ‘expert’ advice on a continuous level. Why, even one prominent Tobacco Control advocate has a PhD in the subject.[8] I wonder how many millions have been spent by the various Tobacco Control groups looking into this very topic.

But the main reason I see Tobacco Control as a wolf in sheep’s clothing has nothing to do with the above. It is simply this…

They have fought tooth and nail against the development of e cigarettes and personal vaporizers. They have consistently argued for the over-regulation of harm reduction products. Why would any group which purports to be acting in the interest of people’s health which to stymy, to destroy a product which will save many millions of lives? And to me, again, the answer is simple. It is against their interests to see this happen. For whatever reason, I think, it is important for them to keep their respective positions, be it an organisation or individual within an organisation. It is power, it is money, it is prestige and position, and all of these are up for the taking – as long as a percentage of people continue smoking: As long as it never become known how duplicitous their activities really are.